前列地尔和尼可地尔对行PCI术患者心肌损伤保护作用的探讨

发布时间：2018-06-29 21:54

本文选题：前列地尔 + 尼可地尔　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:冠状动脉粥样硬化性心脏病是目前威胁全人类身体健康的主要疾病之一,它的治疗效果及预后状况备受广泛关注和高度重视。经皮冠脉介入治疗是目前临床常用的一种血运重建的治疗方法。本文旨在临床观察同时应用前列地尔和尼可地尔对行经皮冠脉介入治疗的不稳定型心绞痛患者心肌损伤保护作用的探讨。方法:选择于青岛大学医学院附属医院心血管内科门诊就诊且确诊为不稳定型心绞痛,需住院行PCI手术的患者120例作为研究对象,随机分为4组,每组各30例。对照组入院后据相关指南给予不稳定型心绞痛的常规药物治疗;前列地尔组在常规药物治疗的同时,术前48小时及术后给以前列地尔每次10μg静脉推注,每日一次;尼可地尔组在常规药物治疗的同时,术前48小时及术后给以尼可地尔口服制剂每顿5mg,一天三次;两种药混合实验组在常规药物治疗的基础上,术前48小时及术后同时给予前列地尔每次10μg静脉推注,每日一次及尼可地尔口服制剂每顿5mg,一天三次的治疗。观察比较以上四组PCI治疗前及治疗后6、12、18、24小时血清肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、高敏肌钙蛋白T(hs-c Tn T)的水平。结果:对照组、前列地尔组、尼可地尔组和两种药混合实验组,四组受试者在PCI治疗前研究对象的一般状况和PCI术中所见的冠脉病变数、支架植入数比较均无显著性差异(P0.05)。对照组和三个治疗组的心肌损伤标志物和超敏C反应蛋白(hs-CRP)在冠脉介入治疗术后四个时间段均较冠脉介入治疗术前有所上升。前列地尔组和尼可地尔组患者的血清肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、高敏肌钙蛋白T(hs-c Tn T)的水平在PCI术后6、12、18、24h各自均低于对照组相应时间点水平,差异有统计学意义(P0.05)。两种药混合实验组患者的血清肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、高敏肌钙蛋白T(hs-c Tn T)的水平在PCI术后6、12、18、24h均明显低于对照组相应时间点水平,差异有统计学意义(P0.05)。两种药混合实验组患者的血清肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、高敏肌钙蛋白T(hs-c Tn T)的水平在PCI术后6、12、18、24h均分别低于前列地尔组和尼可地尔组的相应时间点水平,差异有统计学意义(P0.05)。前列地尔组和尼可地尔组患者的血清肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、高敏肌钙蛋白T(hs-c Tn T)的水平在PCI术后6、12、18、24h比较差异无统计学意义(P0.05)。结论:对不稳定型心绞痛患者而言,前列地尔和尼可地尔在PCI相关心肌损伤中具有协同的心肌保护作用,比单用其中一种药物保护效果好。
[Abstract]:Objective: coronary atherosclerotic heart disease is one of the major diseases threatening the health of all mankind. Percutaneous coronary intervention (PCI) is a commonly used method for revascularization. The purpose of this study was to investigate the protective effects of alprostadil and nicorandil on myocardial injury in patients with unstable angina pectoris undergoing percutaneous coronary intervention. Methods: 120 patients with unstable angina pectoris diagnosed as unstable angina pectoris were randomly divided into 4 groups with 30 cases in each group. After admission, the control group was given routine drug therapy for unstable angina pectoris according to the relevant guidelines, while the prostadil group was given 10 渭 g prostadil intravenously before and after the treatment 48 hours before operation and once a day. In the nicorandil group, nikodil oral preparation was given at the same time as routine drug therapy 48 hours before and after the operation, five mg per day, three times a day. The two drugs were mixed on the basis of routine drug therapy. Alprostadil was given 10 渭 g intravenously at 48 hours before and after operation, once a day and 5 mg / d with Nicorandil orally, three times a day. The serum levels of creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) were observed and compared before and after PCI. Results: there was no significant difference in the general status of the subjects before PCI, the number of coronary artery lesions and the number of stents implanted in the four groups in the control group, alprostadil group, nicordil group and the mixed group of two drugs (P0.05). Myocardial injury markers and hypersensitive C-reactive protein (hs-CRP) in the control group and three treatment groups were higher than those before coronary intervention in the four periods after coronary intervention. The levels of serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) in alprostadil group and nicordil group were significantly lower than those in control group at 612 ~ 18h after PCI (P0.05). The serum levels of creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) were significantly lower than those in the control group (P 0.05). The levels of serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) in serum of the patients in the two groups were lower than those in the alprostadil group and nicordil group at 24 h after PCI. The difference was statistically significant (P0.05). There was no significant difference in serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) between the alprostadil group and nicordil group (P 0.05). Conclusion: prostadil and nicorandil have synergistic myocardial protective effect in patients with unstable angina pectoris, which is better than one drug alone.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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